Prompt Payment of Claims. In accordance with 42 CFR 447.46, the Contractor shall comply with the timely claims payment requirements of 42 CFR 447.45. The Contractor shall implement Claims payment procedures that ensure 90% of all Provider Claims, including to I/T/Us, for which no further written information or substantiation is required in order to make payment are paid or denied within thirty (30) days of the date of receipt of such Claims and that 99% of all Claims are processed within ninety (90) days of the date of receipt of such Claims. In addition, the Contractor shall comply with the Prompt-Pay statute, codified within KRS 304.17A-700-730, as may be amended, and KRS 205.593, and KRS 304.14-135 and KRS 304.99-123, as may be amended. The date of receipt is the date the MCO receives the claim, as indicated by its date stamp on the claim or other notation as appropriate to the medium used to file a claim and the date of payment is the date of the check or other form of payment. The Contractor shall notify the requesting provider of any decision to deny a Claim or to authorize a service in an amount, duration, or scope that is less than requested. Any conflict between federal law and Commonwealth law will default to the federal law unless the Commonwealth requirements are stricter.
Appears in 2 contracts
Sources: Medicaid Managed Care Contract, Medicaid Managed Care Contract